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i <br /> U " <br /> City of Orono <br /> Building Permit Application � <br /> for New Structures or Additions <br /> • Mailing Address: permit number: Q S�� <br /> � PO Box 66 <br /> �` �� Crystal Bay, MN 55323-0066 Date rece�ved: —�� <br /> StreetAdd�ss:' ` Received by: <br /> � ,� 2750 Kelley ParkwayC �J � � /_ <br /> ��, � �g Pfan review fee: �p0/• � <br /> ��` Orono, MN 55356 <br /> �'�KFsx:o� Main: 952-259-4600 Total Fee: �'`S ~��7�� <br /> Fax: 952-249-4616 www.ci.orono.mn.us <br /> This appiication form mustbe cornpleteci in full and all required irtformation r�ust be submitted,. �p� w� �p� <br /> Incamplete appfications wi11 be returned. (P/ease print) �k 2,0�4-l�05�0 <br /> GENERAL INFORMATION: <br /> Job Site Address: E <br /> Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? Yes No <br /> !f yes,a special event pemrit is required with Police Department and City Council approvel 60 days prior to the event. Shuttle bus service will be <br /> required unless applicant demonstrates s�cient on-site parking is available. Non permitted events will not be allowed. <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: <br /> State License# �,� ���e � Expiration Date: '3 J'y <br /> Phone: (cell) y►« y7 g�S 3S (office) 76���J��l S3S �� <br /> Mailing Address: Cit : ZIP: <br /> Contact Person: pplicant is: �trac o Homeowner (Clrcle One) <br /> Email and/or Fax: �,,,���,�i ���„c_;��� �, t�1 <br /> PROPERTY OWNER INFORMATIO : <br /> Name: � <br /> Phone (day): <br /> Address: __�Q 6e�t / O � C�h�:�/_�AZ-�'t.� ZIP: !S 5 �1f'p� <br /> Email and/or Fax <br /> ARCHITECT/ENGINEER INFORMATION: <br /> Name: �,�t ARc M►ssc�lvRAL �'t�� s�/� . <br /> Phone (day): » <br /> Address: T /ti$y S•r du 6�• 4trtC:' CitY: �. �Ad` ZIP: � 11�9 <br /> Email and/or Fax: <br /> PROJECT INFORMATION: Descri tion of ro'ect: <br /> 1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8 <br /> Water Supply <br /> New Construction ❑Single Family with ❑Accessory Bldg./Garage <br /> Addition attached garage ❑ Deck ❑ Public Sewer <br /> ❑Accessory Building ❑ Single Family with ❑Office/Commercial <br /> ❑ Relocation detached garage ❑ Residence ❑Private Sewer <br /> ❑ Other: (specify) ❑Multiple Family/Condo ❑ Retaining Wall(s) <br /> ❑ Public 4-feet or greater ❑ Public Water <br /> **Any earth movement may require ❑Commercial ❑ Storage <br /> MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Private Well <br /> Minnehaha Creek Watershed District(MCWD) ❑ Other: (specify) ❑ Other(specify) <br /> 15320 Minnetonka Blvd ' � <br /> Minnetonka,MN 55345" ,.'�, <br /> Phone: 952-471-0590 <br />� Fax: 952-471-0682 <br /> www.minnehaha reek.or <br /> Estimated Construction Valuation (excluding land) $ � ������ q� <br /> -T ' <br /> Packet Last Updafed: January 2015 <br /> Page 20 <br />